Acute Cubital Tunnel Syndrome from Post Traumatic Calcific Neuritis K. AMETEWEE From The Queen Elizabeth Hospital, Barbad’os The normal ulnar nerve is not visible on radiographs of the elbow. An unusual case is described in which symptoms of ulnar nerve compression with a swollen, tender ulnar nerve at the elbow developed after relatively minor trauma. Radiology suggested “Calcific Neuritis”, but this was short lived with complete regression of the symptoms.
Compression Neuropathy of the ulnar nerve is now a well recognised syndrome. The causes may be from a fracture as originally described, or impingment by osteophytes, ganglia and tumours on the nerve. Others are repetitive or acute trauma to the area and various congenital anomalies (Connor, 1983). Calcification of the perineural sheath of the ulnar nerve after minor trauma producing the syndrome, has I believe, never been described. I report a case in which the syndrome was produced by such calcification making the nerve visible on an x-ray of the elbow. The symptoms were short lived. A fifty-five year-old man was involved in an accident. His injuries were, dislocation of the right acromioclavicular joint and a fracture of the distal articular edge of the tibia. He was admitted to hospital for about two weeks for treatment. During this time he made no complaints about pain in the elbow or any injury to the area. About three weeks after the accident, he was seen in a clinic complaining of tingling and numbness in the ring and little fingers of the right hand. He likened it to the feeling of “funny bone” but also remarked that he could feel a swelling at the elbow which was not felt on the other side.
Fig. 1 Fig. 2
Shows ulnar nerve shadow. Three weeks later less visible.
Examination showed no evidence of injury to the right elbow. On feeling around the elbow, the ulnar nerve was felt to be a swollen thickened cord about twice the normal size and tender. It was more easy to roll it behind the medial epicondyle. Examination of the hand confirmed sensory disturbance in the ring and little fingers but no evidence was found of motor impairment. Blood tests, ESR, White Cell count, Calcium, Phosphorus and Alkaline Phosphatase were all normal. X-rays of the elbow showed the ulnar nerve “etched” out and easily visualized (Figure 1). My l:onlusion was that this appearance was produced by calcification in the perineural tissues secondary to trauma. I treated him by immobilizing the elbow in a cast for three weeks. The tingling was slow to subside, but on X-rays, the nerve shadow was less visible (Figure 2). By the end of two months, the nerve shadow was Received for pubhcarion April, 1985 K. Ametewee, MCh. (Orth.) FRCS, Queen
VOL
11-B No. 1 FEBRUARY
1986
Elizabeth
Hospital,
Barbados.
Fig. 3a and 3b. After two months
nerve shadow
invisible.
123
K. AMETEWEE
completely gone (Figure 3). The nerve swelling and tenderness have also subsided. At a recent review nine months after the accident, he still complained of some numbness in the two ulnar fingers but no signs were found at the elbow; the finger numbness was only subjective.
successful outcome of the treatment confirms the observation that whenever soft tissue calcification develops acutely after trauma, rest of the involved part will see the rapid disappearance of the calcification. As to the part of the nerve tissue that was calcified, this can only be conjectured, since no histological studies have been made.
Comment :
The normal ulnar nerve is not visualized on X-rays of the elbow. The sudden radio-opacity and showing of the ulnar nerve on radiography was thus most likely to be due to calcification in the nerve or surrounding tissues. It is interesting that the nerve should be the site of calcification although the local elbow trauma was hardly mentioned by the patient. I ordered an X-ray of the elbow to exclude a possible local fracture with irritation of the nerve. Even though the nerve was palpably thickened the presence of calcification was not suspected as calcification in nerves is almost unknown except in Leprosy and Neuro-fibromastosis. (Meals, 1984). Based on the experience of a similar case already reported (Ametewee, 1983) my treatment was to immobilize the elbow to rest the inflamed nerve. The
124
The possibility of Calcific Neuritis should be strongly considered whenever a peripheral nerve becomes acutely swollen, tender or visible on radiology. It is also likely that this phenomenon can also be explained in part by the large calcium content of the soil and water on this Coral Island. I do not think this was a case of Tumoural Calcinosis known to be prevalent in blacks. (McClatchie, 1969). References AMETEWEE, K. (1983). Carpal Tunnel Syndrome Produced by a Post Traumatic Calcitic Mass. The Hand, 15:2:212-215. CONNOR, J.M. Soft Tissue Cdcficution. Berlin, Heidelberg, New York. Springer Verlag, (1983). p 10. McCLATCHIE, S. BREMNER, A.D. (1969). Tumoural Calcinosis, an unrecognized disease, British Medical Journal, 1: 153-155. MEALS R.A. (1984). Orthopaedic Knowledge up-date, American Academy of Orthopaedic Surgeons, p 156.
THE JOURNAL OF HAND SURGERY

Tunnel of Bones (City of Ghosts #2) - Kindle edition by Schwab, Victoria. Download it once and read it on your Kindle device, PC, phones or tablets. Use features like bookmarks, note taking and highlighting while reading Tunnel of Bones (City of Ghosts #2). Tunnel of Bones PDF book (Cassidy Blake) (Cassidy Blake Series) Read Online or Free Download in ePUB, PDF or MOBI eBooks. Published in September 3rd 2019 the book become immediate popular and critical acclaim in childrens, middle grade books. The main characters of Tunnel of Bones novel are Cassidy Blake, Jacob (Cassidy Blake). The long winter pdf. Keep a lid on it, pandora! pdf free download. There were certain moments, when Cass and Jake were down amongst the bodies of the long dead, surrounded by ghosts and a creepy ch. Tunnel of Bones continues the story of Cassidy Blake, reluctant ghost hunter. This time Cassidy finds herself in Paris, home of the catacombs and a rather pesky poltergeist. Tunnel Of Bones, Cassidy Blake 2 PDF EPUB Download Free Victoria Schwab Kindle reading app on your iPad, iPhone, or iPod touch. Get a free book you really like Tunnel Of Bones, Cassidy Blake 2 PDF EPUB Download Free Victoria Schwab download it to your mobile e-reader. Novels To Read Online Tunnel Of Bones, Cassidy Blake 2 PDF EPUB.

Tunnel Of Bones Pdf Free Download Windows 10

Tunnel Of Bones PDF Free Download